If I Had A Billion Dollars

Well, I'd Buy You a Hospital

If I had a billion dollars and wanted to build in healthcare, I’d buy a hospital. Better yet, I’d build one from the ground up and attach a clinic to it. But this hospital is going to be a little bit different. First, anyone who works there will have an ownership stake. From doctors to nurses, physical therapists to x-ray techs, custodial staff to phlebotomists, if you contribute to our success, you get to benefit. Nothing spurs a sense of pride like ownership. Heck, maybe we’ll even be like Lambeau Field and have some public ownership too. Put the “community” back in community hospitals. Of course, physician ownership of hospitals is still banned in the US so we might have to build somewhere else. But don’t worry, we’ll put it some place nice. Medical tourism is all the rage anyway.

We’ll be a specialty hospital/clinic at first, focused on MSK. Bones is what I know, and it ain’t brain surgery. Not to mention, with an aging population, demand for Orthopedic care is expected to outstrip supply. Treatment is expensive too — $420 billion in 2018. MSK conditions cost the U.S. healthcare system more than any other chronic condition including behavioral health, diabetes, cancer, and cardiovascular conditions. The business case is strong in Ortho. There’s money to be made for sure, but there are savings and quality improvements to be had along the way. It’s a rare opportunity for win-win healthcare innovation.

Source: Musculoskeletal Disorder Costs and Cares | Evernorth

Quality of care is variable too. There’s been a lot of focus on reducing MSK spend, but much of it directed at reducing overtreatment and preventing unnecessary care. We’ll do that too…but won’t stop there. Fragmentation is no good, so we’ll encompass the entire spectrum of care. We’ll commit to transparency, evidence-based care, robust and meaningful data collection/analysis, and constant improvement and evolution. But it won’t be cookbook medicine — healthcare is practiced at the individual level. Whole person care will be baked into our approach because you can’t underestimate the mind-body connection. Primary care and mental health are intertwined with Orthopedic health. We’ll embrace this concept and build upon it. Once the MSK model is proven, we’ll expand to other specialties.

Our hospital won’t take insurance — at least not right away. Maybe we never will. But we’ll work hard to make our care affordable, our prices transparent, and our value undeniable. Insurance complicates things. It drives up administrative costs, forces perverse incentives, confuses patients, and creates games. Getting sucked into insurance games is a sure-fire innovation killer, and we’re not going there. To maintain accessibility, we’ll know exactly what our care costs. We’ll keep bloat to a minimum (without sacrificing quality) and drive efficiency by measuring everything we do. Eventually, we’ll work with ACOs, employers, Medicaid programs, and even CMS — provided they’re interested in fair negotiations and working together to create sustainable models. Value will be intrinsic to our approach, not forced by a payment model. We won’t need ineffectual carrots or sticks. Once we’re up and running and on solid financial footing, we’ll commit to real charity care too. Free care really will be free. If we can do medical missions abroad, we can do medical missions domestically too.

Our hospital will make “not for profit” actually mean something (beyond a tax status). Every dime we make will be rolled back into making things better for patients and rewarding those providing the care. Our staff will be well compensated — not just monetarily but with autonomy and a sense of purpose. We’ll have a flat leadership structure, not layers of administration far removed from what’s happening on the frontlines. No meetings without purpose. No pointless tasks. No checking of boxes for the sake of box checking. The Joint Commission is welcome to come, but we’re not going to scramble around in a panic when they show up. If nurses want to have food and beverages at their stations, so be it. Unless irrefutable data can be presented otherwise, you can wear whatever head covering you want. We’ll follow evidence-based practices and common sense, not arbitrary protocols. Maybe they won’t accredit us. Maybe it doesn’t matter.

Source: Association between patient outcomes and accreditation in US hospitals: observational study (bmj.com)

We’ll have tech aplenty. But not tech that gets in the way, tries to replace doctors, or destroys workflows. The best tech fades into the background. By incorporating digital tools from the get-go, our tech will be integrated, not retrofit. Use of data will be transparent and patient privacy will be protected. Not having to satisfy billing codes through meaningless documentation, our data will be cleaner with a clinically relevant medical record. Better data will lead to better insights which in turn will lead to higher quality, less expensive care. Our tech will facilitate patient engagement, allow for multiple touch points, and enhance the doctor-patient relationship. Properly designed and implemented, it will reduce readmissions, complications, and unnecessary visits without sacrificing our connection with our patients.

Yep, our hospital is going to be pretty special. We’re going to take every pain point and turn it into a strength. No more excuses. No more bowing to the power of incumbency. No more "because that’s the way we’ve always done it.” No more profiteering, empty mission statements, and financial shell games. If I had a billion dollars. Actually, better make it two.